98- Successful percutaneous transgluteal embolization of a complex arteriovenous malformation feeding a hypogastric artery aneurysm

Pelvic arteriovenous malformation (AVM) is a rare condition mostly requiring a complex therapeutic strategy. The surgical approach is challenging and burdened by relatively high mortality and morbidity rates. No guidelines are available for the endovascular treatment of AVM because the literature is limited to small case series and case reports. We present a complex case of a pelvic AVM associated with an internal iliac artery aneurysm in a patient previously treated with a common to external prosthetic substitution for aneurysm and proximal ligation of internal iliac artery.

An arteriovenous malformation (AVM) consists of multiple anarchic communications between the arterial and venous systems. Pelvic AVM is a rare but extremely distressing condition and represents 1.8% of the major abdominal AVM localizations. Its treatment, either open or endovascular, is challenging because of the anatomic characteristics, the deep location, and the high hemorrhagic and ischemic risks.1

Pelvic AVM has different causes (idiopathic, post-traumatic, neoplastic, and congenital) and can be life-threatening during delivery or rupture (spontaneous or post-traumatic).2, 3 Iliac AVM is sometimes associated with a hypogastric artery aneurysm (HAA) and can lead to an arteriovenous fistula.4 Because of the high hemorrhagic risk, surgical removal of an ilioiliac AVM is rarely indicated.5 We present a complex case of a pelvic AVM associated with a right internal iliac artery aneurysm. The patient agreed to publication of the case.